global burden and unmet need for hyperbilirubinemia …
TRANSCRIPT
GLOBAL BURDEN AND UNMET NEED FOR HYPERBILIRUBINEMIA TREATMENTB. K. CLINE1, 2, R. VILMS3, K. MCGRAW4, H. H. LOU1, K. M. DONALDSON1, 2, V. K. BHUTANI3
1D-REV: DESIGN FOR THE OTHER 90%, PALO ALTO, CA 2HASSO PLATTNER INSTITUTE OF DESIGN, STANFORD UNIVERSITY, STANFORD, CA
3DIVISION OF NEONATOLOGY AND DEVELOPMENTAL MEDICINE, DEPARTMENT OF PEDIATRICS, STANFORD UNIVERSITY, STANFORD, CA
CONCLUSIONSOur preliminary e�ort to estimate the global burden of SNH suggests that the unmet need for e�ective phototherapy treatment exceeds 6 million newborns annually. Increasing the global availability of e�ective phototherapy could reduce the adverse consequences of SNH and kernicteric mortality, as well as reduce the need for exchange transfusions.
ACKNOWLEDGEMENTSSupported in part by NCIIA Grant 6885-09.
RESULTS
SUMMARYWe estimate that annually at least 14.1 million babies worldwide (10.5% of live births) require phototherapy (see Table 1). Of these, more than 6 million infants of those requiring treatment (~45%) do not receive e�ective treatment, and approximately 100,000 reach extreme hyperbilirubinemia of TSB ≥30 mg/dL, a threshold associated with brain damage. The largest unmet need in absolute and percentage terms is in South Asia and Africa, particularly because of a high number of births and pre-term births, weak health systems, and hereditary risk factors.
METHODS
INTRODUCTION
OBJECTIVETo provide an initial estimate of the total and unmet need for neonatal phototherapy globally, with an emphasis on resource-limited settings.
Severe neonatal hyperbilirubinemia (SNH) that is untreated poses a signi�cant global public health challenge. However, national-level data from resource-limited countries are scarce, and global and regional estimates for the unmet need for phototherapy treatment are unavailable.
Based on our literature review of the incidence of SNH requiring phototherapy, we modeled regional incidences of SNH using International Classi�cation of Diseases, Ninth Revision (ICD-9) coded data on phototherapy treatment in the United States,1 with adjustments for term/preterm birth ratios,2 di�erences in hereditary risk factors for hyperbilirubinemia (glucose-6-phosphate dehydrogenase de�ciency3). We also adjusted for under-reporting in ICD-9 codes for neonatal noninvasive procedures.4 We estimated availability of phototherapy, for which data is scanty, using a World Health Organization indicator for pediatric healthcare coverage.5 To determine the incidence of bilirubin concentrations in excess of 25 and 30 mg/dL, we conservatively assumed a distribution of hyperbilirubinemia severity similar to previously published US studies.7,8
Figure 1. Flow chart of illustrating burden calculation methodology
Design Revolution
Figure 3. Estimated total unmet need for phototherapy treatment by region.
LIMITATIONS
REFERENCES1 Burke BL, Robbins JM, Bird TM et al. Trends in hospitalizations for neonatal jaundice and kernicterus in the United states 1988–2005. Pediatrics 2009; 123: 524–32. 2 Beck S, Wojdyla D, Say L, Pilar Betran A, Merialdi M, Harris Requejo J, Rubens C, Menon R, Van Look P: The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity. Bull World Health Organ 2010, 88(1):1-80.3 Glucose-6-phosphate dehydrogenase de�ciency. WHO Working Group. Bull World Health Organ 1989;67:601-11.4 Ford JB, Roberts CL, Algert CS et al. Using hospital discharge data for determining neonatal morbidity and mortality. BMC Health Services Research 2007; 7:188. 5 World Health Organization. Global Health Observatory Database. “Health service coverage, Reproductive healthcare”. (Accessed October 20, 2010 at http://apps.who.int/ghodata/ ).6 Bhutani VK, Johnson L. Kernicterus in the 21st century: frequently asked questions. J Perinatol 2009; 29 Suppl 1:S20-4.7 Newman TB, Klebano� MA. Neonatal hyperbilirubinemia and long-term outcome: another look at the Collaborative Perinatal Project. Pediatrics1993; 92(5): 651-7.
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We adjusted for genetic di�erences in risk by scaling the portion of SNH due to G6PD de�ciency according to prevalence of the enzyme disorder. G6PD de�ciency may have a varying relationship to severe nenonatal hyperbilirubinemia in countries with a di�erent prevalence of this disorder.Our estimate is conservative, as we do not account for the higher prevalence of environmental risks, including sulfa drug exposure and hemolytic triggers, as well as the e�ect of sub-optimal health infrastructure, which increases the incidence of sepsis and thereby hyperbilirubinemia.
Table 1. Regional estimates for total and unmet need for phototherapy treatment and incidence of elevated bilirubin concentrations. Insu�cient data was available for estimation of unmet need and bilirubin concentrations in Europe, North America, and Oceania, thus leading to an underestimation of the world total (indicated by *).
LegendcountriesPercentage_of_live_births_requiring_phototherapy / none
0.031532189 - 0.065223935
0.065223936 - 0.098915681
0.098915682 - 0.132607427
0.132607428 - 0.166299172
0.166299173 - 0.199990918
LegendcountriesPercentage_of_live_births_requiring_phototherapy / none
0.031532189 - 0.065223935
0.065223936 - 0.098915681
0.098915682 - 0.132607427
0.132607428 - 0.166299172
0.166299173 - 0.199990918
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Figure 2. Estimated total annual need for phototherapy treatment by region.
LegendcountriesPercentage_of_live_births_requiring_phototherapy / none
0.031532189 - 0.065223935
0.065223936 - 0.098915681
0.098915682 - 0.132607427
0.132607428 - 0.166299172
0.166299173 - 0.199990918
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